Cost effectiveness of the New Zealand diabetes in pregnancy guideline screening recommendations

Objective: To compare the cost-effectiveness of 2 possible screening strategies for gestational diabetes mellitus (GDM) from the perspective of the New Zealand health system, developed as part of a gestational diabetes guideline. Design: A decision analytic model was built comparing 2-step screening (glycated haemoglobin (HbA1c) test at first booking and a 2 h 75 g oral glucose tolerance test (OGTT) as a single test at 24–28 weeks) with 3-step screening (HbA1c test at first booking and a 1 h glucose challenge test (GCT) followed by a 2 h 75 g OGTT when indicated from 24–28 weeks) using a 9-month time horizon. Setting: A hypothetical cohort of 62 000 pregnant women in New Zealand. Methods: Probabilities, costs and benefits were derived from the literature, and supplementary data was obtained from National Women's Annual Clinical Reports. Main outcome measures, screening and treatment costs (NZ$2013) and effect on health outcomes (incidence of complications). Results: The total cost for b...

研究目标：从新西兰医疗卫生系统视角出发，对比两种妊娠糖尿病（gestational diabetes mellitus, GDM）筛查方案的成本效益，本研究为妊娠糖尿病诊疗指南制定工作的一部分。
研究设计：构建决策分析模型，以9个月为时间跨度，对比两步筛查法与三步筛查法的效果。两步筛查法为：首次产检时行糖化血红蛋白（glycated haemoglobin, HbA1c）检测，于孕24~28周行单次2小时75克口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）；三步筛查法为：首次产检时行糖化血红蛋白检测，于孕24~28周先行1小时葡萄糖激发试验（glucose challenge test, GCT），若结果符合指征则后续行2小时75克口服葡萄糖耐量试验。
研究场景：以新西兰境内62000名孕妇的假想队列作为研究对象。
研究方法：概率参数、成本与收益数据均来源于已发表文献，补充数据取自《国家妇产医院年度临床报告》（National Women's Annual Clinical Reports）。
主要结局指标：筛查与治疗成本（以2013年新西兰元计价）及健康结局影响（并发症发生率）。
研究结果：The total cost for b...